With checking blood sugars, administering injections, taking medications, and attending doctor’s appointments, there is a lot that goes into managing your diabetes. As a diabetic, it can feel like there are a lot more important aspects to focus on than caring for your feet, but foot problems can quickly become serious if not identified and treated promptly. Over time, high blood sugars, also known as glucose, can damage the nerve and blood vessels in the feet. These changes can affect feeling, sensation, and blood flow to the feet, in turn putting diabetics at risk of developing skin ulcers, infections, and wounds that will not heal.

Regularly examining your feet along with proper foot care are the best ways to prevent foot complications down the road. It is important to get familiar with your feet so that if a problem does arise, you will notice it quickly and can get treated for it right away. It may take some time and effort to create a good foot care routine, but it is essential in the management of diabetes.

Common Foot Complications

Nerve damage and poor blood flow, which are commonly seen in people with diabetes, can put patients at risk of developing an open wound on their foot. Due to the anatomical changes of the body in diabetic individuals, these wounds can easily become infected and not heal properly if left untreated. In many situations, a simple wound to the foot may require medical intervention, including removing dead skin and tissue, or debridement, and applying topical medication and dressings to the wound.

If a wound is left untreated for too long and becomes infected, the infection can spread to other parts of your body. In severe cases, this can require the surgical removal of your toe, foot, or even leg through a surgery called an amputation. These sores can be prevented through routine foot care and checkups with your podiatrist, or foot doctor. When you check your feet daily, you can catch problems early on before infections develop, which greatly decreases the risk of amputation.

Nerve Damage

The CDC suggests that nearly half of all people with diabetes have some type of nerve damage. We generally see nerve damage begin in the lower extremities, which is why medical professionals stress the importance of taking good care of and closely monitoring your feet. Nerve damage, also known as diabetic neuropathy, is caused by a long history of elevated blood sugars. Over time, high blood glucose can damage your nerves, which can cause them to stop sending messages throughout your body. Nerve damage can affect your ability to feel different sensations such as pain, heat, or cold. This is how nerve damage can be detrimental to foot health, as you may have a blister on your foot, but it goes unnoticed until it becomes infected, as you can no longer feel the pain in your foot. Diabetic neuropathy can also cause symptoms such as pain, numbness, tingling, or a “pins and needle” feeling, making it difficult to perform normal activities.

Anyone with diabetes is at risk of developing nerve damage, but the following factors increase your risk:

  • Having uncontrolled, high blood sugars
  • Having diabetes for a long time
  • Being overweight
  • Being over 40 years old
  • Having high blood pressure
  • Having high cholesterol

Symptoms of nerve damage tend to develop slowly and begin in the feet, which is why it is important to see your podiatrist regularly. If you continue to struggle with elevated blood sugars, it is possible to see nerve damage to other parts of your body, including your hands, digestive tract, and even your heart.

Current treatment includes pain and symptom management through medications. Though there is no cure for diabetic neuropathy once it develops, it is possible to slow the spread of nerve damage and prevent it from worsening. The best way to prevent further nerve damage is to keep your blood glucose close to your target range. Maintaining healthy blood glucose will help prevent any nerve damage from occurring, to begin with. This can be done by eating healthy, exercising regularly, checking your blood sugars as instructed by your doctor, and taking all medication, including insulin, as prescribed.

Poor Blood Flow

Lack of blood flow is commonly seen in those with diabetes. Similar to nerves, a long history of elevated blood sugar levels can damage the blood vessels by causing them to harden and narrow. These blood vessels, in turn, struggle to carry adequate amounts of blood to the feet and legs. Lack of blood can damage the skin to this area, making it more prone to ulcers and impairing wound healing. Certain bacteria also thrive on high glucose levels, so if a wound becomes infected, it can cause further skin breakdown and eventually make ulcers worse.

Poor circulation to the feet can decrease and even prevent the body’s ability to heal wounds and fight infections. There are things you can do to improve blood flow and prevent further damage to your blood vessels:

  • Quit smoking. Smoking also causes your blood vessels to harden, further reducing blood flow to your feet. Quitting smoking is the most important thing you can do to prevent worsening circulation.
  • Manage your blood pressure and cholesterol by following the advice of your medical professional.
  • Exercise regularly as it stimulates blood flow to the legs and feet.
  • Elevate your feet while sitting and wiggle your toes to stimulate blood flow throughout the day.

Skin Changes

Along with nerve damage and poor circulation, diabetes can cause unwanted changes to the skin of your feet. You may notice small, round, brown patches of skin on your shins. This is a harmless condition called diabetes-related dermopathy. These changes are caused by poor blood flow affecting the body’s ability to control oil and moisture in your feet and legs. You may also notice your feet becoming very dry, start to peel, or even crack. It is important to apply lotion to the tops and bottoms of your feet regularly to offset the dryness that can come with diabetes. Do not apply lotion between the toes, as the added moisture to that area can increase the risk of developing a fungal infection. If you do notice signs of a fungal infection, such as inflamed skin, itchiness, or scaly skin between the toes, you should see your doctor immediately to be treated.

Ulcers

Diabetic ulcers are one of the most common complications seen in diabetic patients. They are open sores, or wounds, that do not heal the way they should.  They tend to occur on the ball of the foot or the bottom of the big toe but they can develop anywhere including your hands and folds of your stomach. Ulcers can be caused by numerous different things, including poor-fitting shoes, stepping on a rock, or resting your foot in one position for too long.

Even if an ulcer doesn’t hurt or appears to be healing, it is important to have it examined by your doctor immediately. Neglecting a new ulcer can result in infections to the wound, blood, or even the bone.

When to See a Doctor

If you notice or experience any of these signs or symptoms, make an appointment to see your doctor immediately:

  • Cramps to your legs or buttocks during exercise
  • Tingling, pain, or burning in your feet
  • Loss of sense of touch or ability to feel hot/cold well
  • A change to the shape of your feet
  • Loss of hair on your toes, feet, and legs
  • Thickened, yellow toenails
  • A blister, sore, ulcer, infected corn, or ingrown toenail to your feet
  • Fungus infection to your feet or toes such as athlete’s food
  • Dry and cracked skin to your feet
  • A change to the color or temperature of your feet

Serious foot complications can be prevented with regular foot care at home and attending all doctor’s appointments. If you do see a problem begin to arise, acting quickly to see a doctor can stop a small problem from becoming more serious.

Doctor Bandaging Foot

Preventing Foot Problems in Diabetes

  • Check your feet daily for any changes to your skin or nails, including swelling, cuts, sores, blisters, or calluses. Ask a friend or family member or use a hand-held mirror to help assess those hard-to-see areas.
  • Get your feet checked at each healthcare visit. It is important to have multiple sets of eyes on your feet to assess for any changes.
  • Visit your podiatrist yearly. He or she will perform a thorough examination of your feet, including checking for any nerve damage and poor circulation in your feet. They can also trim your toenails if you can’t see or reach your feet.
  • Wash your feet daily with lukewarm, water. Avoid soaking your feet in bodies of water like baths and hot tubs, as it can open your skin up to a possible infection. Make sure you dry your feet completely and gently after washing and apply lotion regularly to keep them moist. Avoid lotion use between the toes, as it could lead to a fungal infection.
  • Use antiperspirant on your feet to prevent unwanted moisture throughout the day. The sweat from your feet can put you at risk of developing a fungal infection.
  • Keep the blood flowing to your feet to prevent any complications. Elevating your feet while sitting can help improve blood flow, along with wiggling your toes regularly throughout the day.
  • Wear shoes and other footwear that fit properly. Your feet can swell by the end of a long day, so try on new shoes at the end of the day when you’re feet are the largest. Break in new shoes slowly to decrease the risk of developing any blisters or sores. Before putting your shoes on, make sure the lining is smooth and nothing is inside your shoe like a pebble or small twig. Also, be careful about choosing socks that don’t have any stitching or lining that may irritate the skin throughout the day.
  • Never go barefoot to avoid possible injuries. Even small injuries like stepping on a pebble or stubbing your toe can lead to an infected wound.
  • Take care of your feet by trimming your toenails regularly. Gently file any sharp edges to prevent ingrown toenails. If you have difficulty reaching or seeing your feet, your podiatrist can help trim your toenails.
  • Visit medical professionals to remove any corns or calluses you may have. Do not attempt to remove them yourself as you may cut your foot unintentionally. You should also not remove these by using over-the-counter products. These products can burn your skin and cause an ulcer.
  • Choose feet-friendly activities like riding your bike, walking, or swimming. Avoid activities that put your feet at risk, such as walking barefoot.

Always check with your doctor about other ways to keep your feet healthy!

Preventing Foot Problems in Diabetes

Proper management of your blood glucose can help decrease your risk of developing not only foot complications but any other medical complications related to your diabetes. Regularly follow up with your doctor, as they will work with you in keeping your blood sugars within your target range. Depending on your activity level and diet, your insulin dose and/or types may need to be adjusted. Take all medications as prescribed and follow your diabetes meal plan as suggested by your doctor or dietician. It may feel overwhelming at times, but managing glucose levels will help prevent diabetic complications in the future.

Testing Blood Sugar Levels